Video
How diabetes affects your emotions - \Diabetic coma and emotional well-being -
A new study, however, says that the condition should be categorized as five types. New guidelines from the American College of Physicians recommend that clinicians aim for moderate blood sugar levels in patients with type 2 diabetes….
Researchers said baricitinib, a drug used to treat rheumatoid arthritis, showed promise in a clinical trial in helping slow the progression of type 1….
A new review indicates that insulin—used to manage diabetes—can be kept at room temperature for months without losing its potency. My podcast changed me Can 'biological race' explain disparities in health?
Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us.
Medical News Today. Health Conditions Health Products Discover Tools Connect. How do you recover from a diabetic coma? Medically reviewed by Kelly Wood, MD — By Kate Bass BSC — Updated on January 22, Recovery Causes Prevention Takeaway.
How we vet brands and products Medical News Today only shows you brands and products that we stand behind. Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we: Evaluate ingredients and composition: Do they have the potential to cause harm?
Fact-check all health claims: Do they align with the current body of scientific evidence? Assess the brand: Does it operate with integrity and adhere to industry best practices? We do the research so you can find trusted products for your health and wellness.
Read more about our vetting process. Was this helpful? Recovery from a diabetic coma. Causes of a diabetic coma. Preventing a diabetic coma. Q: My doctor has just told me I have type 2 diabetes. A: A diabetic coma is unlikely as long as you take your medications as prescribed and monitor your blood glucose levels routinely.
Talk to your doctor if you are concerned about your glucose levels being too high or low. How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.
We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles.
You can learn more about how we ensure our content is accurate and current by reading our editorial policy. The needs of people with T2D may be different than those with T1D, but it is unclear if the difference in pathophysiology alone accounts for differences in length of stay [ ].
A recent systematic review of the associations between gestational diabetes mellitus GDM , anxiety, and depression in pregnant individuals found a bidirectional relationship in that anxiety and depression as well as other stressors, such as a history of childhood sexual abuse and experiencing intimate partner violence during pregnancy resulted in a higher incidence of GDM [ ].
Additionally, a diagnosis of GDM increased the subsequent incidence of anxiety and depressive disorders [ ]. Another meta-analysis indicated that the highest levels of depressive symptoms for individuals with GDM occur right around the time the condition is diagnosed [ ]. This may be due to the increased psychological strain of having a new diagnosis that could negatively impact pregnancy outcomes and the increased demands in diabetes self-management tasks [ ].
However, a population-based study in Canada explored mental illness rates including anxiety and MDD in individuals prior to pregnancy, during pregnancy, and postpartum. It was found that, although the prevalence of mental health issues was higher in those with GDM versus those without GDM, there appeared not to be a temporal relationship between GDM and subsequent incidence of psychiatric diagnoses [ ].
Differences were hypothesized to be more likely related to gestational increases in weight [ ]. Additionally, there did not appear to be significant mental health differences in those diagnosed with GDM early in pregnancy versus during the typical screening period for GDM in pregnancy [ ].
Despite these disparate findings, the consensus is that there is a higher prevalence of psychiatric symptomatology in individuals with GDM and that the symptoms are often underdiagnosed [ ].
Screening instruments and rating scales, such as the single-item Self-Rated Mental Health Question SRMHQ , can be helpful in individuals with GDM [ ]. A study using mindfulness-based counselling interventions has demonstrated some initial effectiveness in decreasing anxiety in individuals with GDM, but more research is needed to compare this treatment with other evidence-based approaches [ ], as well as examine whether lifestyle-based interventions that address weight fluctuations during pregnancy are effective at reducing depression symptoms [ ].
Another study examined the trajectory of depressive and anxious symptoms in a group of individuals with PGM only, and the results indicated that these symptoms remained unchanged from early to late pregnancy [ ]. Optimal support for this population would involve:.
GDM, PGM, and postpartum depression: A population-based study examining postpartum depression PPD rates in individuals with diabetes in pregnancy DIP , which includes individuals with either GDM or PGM, found a 1. Another recent meta-analysis replicated the association between those with DIP and PPD but cautioned that when those with GDM versus PGM were compared, the individuals with GDM were the ones more at risk for developing PPD [ ].
Another study found that although individuals with DIP all had significant levels of distress, the highest level of negative pregnancy outcomes was found in those with PGM and negative psychological outcomes were found in individuals with GDM [ ]. The SARS-CoV-2 COVID pandemic can also worsen symptoms.
In addition, 2 factors unintended pregnancies and lower social support were associated with higher levels of anxious and depressive symptoms for individuals with DIP. This may also be related to the effects of social isolation during the pandemic based on fears of a more severe COVID infection for those with diabetes [ ], which may improve with diabetes education and medical support that focuses on the emotional burden of DIP and diabetes regimen-related concerns [ ].
Individuals with pregnancy in diabetes have a higher prevalence of various psychiatric conditions particularly mood and anxiety disorders , which are often underdiagnosed [ ]. One study found that higher levels of medical support experienced by individuals with DIP significantly reduced levels of anxious and depressive symptoms and may buffer the negative outcomes [ ].
For children and adolescents, there is a need to identify mental health disorders and psychosocial issues associated with T1D in order to be able to institute early interventions.
Children and adolescents with T1D have significant risks for mental health issues, including depressive symptoms, anxious symptoms, altered feeding and eating, and disruptive behaviours [ — ].
These risks increase significantly during adolescence [ , ] and into young adulthood. Studies have shown that mental health disorders predict difficulties with diabetes management and glycemic variability [ — ] and worsen medical outcomes [ 47 , — ].
The more glycemic levels are not within target range, the probability of mental health issues also increases [ ]. Adolescents with T1D have been shown to have rates of DD that are comparable to adults with T1D [ 16 ]. An initial study of parental self-report suggests that the use of hybrid closed-loop systems for insulin delivery in children may help ameliorate some parental FoH and poor sleep quality symptoms that may lead to improved glycemic stability for the child [ ].
Maternal anxiety and depressive symptoms are often associated with higher glucose instability and school absenteeism in younger adolescents with T1D, and a reduction in positive mood and motivation for their own diabetes care in older teens [ , ].
Eating disorders are also associated with less metabolic stability, in addition to an earlier onset and faster progression of microvascular complications [ ]. Adolescent and young adult females with T1D who have difficulty achieving and maintaining glycemic targets—particularly if insulin omission is suspected—may also have problematic eating behaviours including subclinical disordered eating behaviours and eating disorders.
Individuals with disordered eating behaviours may require different management strategies to optimize glycemic stability and prevent microvascular complications [ ]. The prevalence of anxiety disorders in children and adolescents with T1D in one study was found to be The presence of psychiatric disorders was related to elevated glycemic levels and a lowered health-related quality of life score in a general pediatric quality of life inventory study [ ].
In the diabetes mellitus—specific pediatric quality of life inventory, children with mental health disorders revealed more symptoms of diabetes, higher treatment barriers, and lower self-management behaviours than children without mental health disorders [ ].
Adolescents with T1D ranked school as their number 1 stressor, their social lives as number 2, and having diabetes as number 3 [ ]. Children and adolescents with T1D, as well as their families, benefit from screening for mental health disorders and psychosocial issues also referred to as person-reported outcome measures [PROMs] at the time of diagnosis, as well as at regular intervals [ ].
Given the prevalence and impact of mental health issues, psychosocial screening of children and adolescents with T1D is just as important as screening for microvascular complications [ , ]. A promising addition to traditional in-person clinic visits is the use of telehealth services, which increased out of necessity during the COVID pandemic but may be a lasting option.
Online meeting rooms, such as virtual group appointments or digital health interventions e. mHealth apps demonstrate improvements in diabetes-related distress [ ] and self-efficacy [ ], as well as parental ratings of quality of life [ ].
In order to prepare for the transition from pediatric to adult diabetes care, a transition plan should be initiated at around 12 years of age so that services including diabetes education, transition readiness assessments, setting transition goals, etc. can occur early enough to prepare adolescents and their families [ , ].
Psychological interventions, which include cognitive-behavioural as well as other complementary psychotherapy approaches e. art therapy , have a positive impact on mental health of children and adolescents with T1D and their families [ , ], including overall well-being [ ], perceived quality of life [ , ], and reduction in depressive symptoms [ , ].
Psychosocial interventions can positively affect glycemic stability[ , ]. Other studies have demonstrated that psychological interventions can increase both diabetes self-management behaviours and frequency of in-target glycemic levels, as well as overall psychosocial functioning [ , ].
Mental health concerns play a significant role in children and adolescents with T2D across all ethnic groups, particularly depression [ ] and binge eating behaviours [ ].
These psychosocial issues, along with disruptive sleep habits [ ], are associated with lower diabetes self-management success and quality of life [ , ]. Moderate-to-severe depression rates in young adults who were diagnosed with T2D in childhood have also been associated with high levels of DD [ ].
Presently, there is a lack of high-quality research data on the impact of MDD and depressive symptoms in youth with T2D. The majority of the studies in this population do not assess for a formal diagnosis of MDD, although depressive symptoms are common in youth and more likely to be associated with adverse diabetes outcomes [ ].
T2D does not appear to be more common in geriatric-aged people with psychiatric conditions than similarly aged controls. The risk of developing a dementing illness in people is increased in those who have MDD hazard ratio [HR] 1. The presence of depressive symptoms in older adults with T2D is associated with increased mortality risk [ ].
Totalling the PHQ-9 scores for the symptoms of diminished interest, sleep changes increase or decrease , psychomotor changes retardation or agitation , and diminished concentration symptoms to 4 or above has an enhanced specificity for detecting MDD in older people [ ].
Overweight status, limited physical capabilities, and reduced activity level, along with the presence of more than 2 comorbid illnesses, were risk factors for MDD in older people with diabetes mellitus. In a case—control study done in China, metformin was found to reduce the risk of developing MDD in older people with diabetes [ ].
Access to ongoing psychosocial interventions through technological platforms may potentially minimize diabetes complications and improve health-related outcomes [ , ]. Telehealth-related technologies can be effective in improving the clinical, behavioural, and psychosocial outcomes in people with diabetes above 50 years of age.
Prescription choices for older people with diabetes mellitus and MDD should factor in antidepressants with a higher likelihood of safety and tolerability [ ]. Recreational substance use is common in Canada.
Among the general population, the prevalence of consumption is: [ , ]. Most studies find that prevalence of substance use among people with diabetes mirror the prevalence rates found in people without diabetes.
Excess substance use leads to physical health complications in major organ systems leading to increased morbidity and premature mortality.
This makes substance use among people with diabetes of particular concern because of the additive health risks. Evidence suggests that substance use has a complex effect on diabetes. In people without diabetes, consumption of tobacco or alcohol increases the risk of developing diabetes [ , ].
In persons living with diabetes, substance use is linked with adverse health outcomes, particularly complications of diabetes [ , ].
These observations can be partly explained by the deleterious effects of the substance directly on glucose homeostasis. A large body of literature suggests that substance use is associated with greater risk for the development of T2D [ , ].
A meta-analysis of 25 cohort studies found an increase in the relative risk for new-onset diabetes among people who smoke cigarettes RR 1. The heightened risk for heavier smokers has a number of hypotheses, including the stimulant effects of nicotine leading to insulin resistance, the potentially toxic effects of substances e.
heavy metals found in tobacco on the pancreas, and the positive correlation between the number of daily cigarettes smoked and abdominal obesity [ ]. Quitting smoking, while having a myriad of health benefits, paradoxically appears to be associated with a transient increase in the risk of new-onset diabetes.
In the first years after quitting, the hazard ratio for new-onset diabetes in successful quitters is higher than with active smokers HR 1.
This risk peaks years after quitting and declines over time [ ]. The modest elevation in risk for new onset of diabetes after quitting does not negate the benefits of quitting smoking on cardiovascular health, as evidenced by a decrease in the incidence of acute coronary events and death [ ].
On a cross-sectional level, the lowest risk for new-onset diabetes appears to be among those with moderate alcohol consumption. The relationship was curvilinear, with highest risks observed in those with alcohol consumption over 4. Events such as acute pancreatitis that follow heavier episodes of alcohol consumption are an established risk factor for new-onset diabetes [ ].
Some studies suggest that the type of alcohol consumed may also influence the health benefits, with wine conferring greater risk reduction benefits than beer or spirits [ ]. Compared with tobacco and alcohol, there is less evidence regarding the association of cannabis use and new-onset T2D.
Two cross-sectional studies actually detected a modest reduction in the prevalence of obesity and diabetes among people who use cannabis [ , ], while 2 cohort studies reported conflicting results; one showing an increase in risk for pre-diabetes among those who consume cannabis that was not observed in the other [ , ].
Limited evidence exists regarding the risk of T2D in people who use opioids for non-medical purposes. Prescription opioids do not appear to be associated with an increase in the risk of new-onset diabetes [ ]. Nevertheless, people with opioid use disorders who receive opioid agonist therapy OAT with methadone appear to be at a higher risk for developing diabetes compared with those receiving naloxone-buprenorphine [ ].
It is well-established that regular, sustained substance use is associated with unfavourable health outcomes.
Among persons with diabetes, those with heavy substance consumption patterns exhibit higher rates of diabetes-related morbidity and earlier mortality [ ].
The deleterious effects of substance use vary with age and type of diabetes. The propensity of substances to worsen glycemic stability has been attributed to a direct effect on glucose homeostasis and an indirect effect mediated through diminished levels of diabetes self-management [ ].
Cigarette smoking can interfere with glucose homeostasis among persons with T1D. Smoking is linked with greater odds of hypoglycemic events OR 2.
Compared with non-smokers, smokers spent greater time in either hypoglycemic or hyperglycemic states and less in normoglycemia [ ].
Hypoglycemia could be partly explained by a co-consumption of cigarettes and alcohol [ ] and by inadequate diabetes self-management found among smokers [ ]. In persons with T1D, alcohol reduces plasma glucose levels and interferes with hypoglycemic counter-regulatory mechanisms.
The onset of hypoglycemia usually appears hours following alcohol consumption. The sedating effect of alcohol may also reduce the awareness of hypoglycemia. Together, these effects of alcohol can increase the risk of severe hypoglycemic events [ ]. Alcohol use among people with T1D can interfere with disease self-management and lead to missed doses of insulin [ ], which may explain the greater risk of DKA among young people with T1D who misuse alcohol [ , ].
Managing alcohol consumption can be a challenge for young people in an environment that promotes alcohol use, such as post-secondary institutions [ ]. Stimulants e.
cocaine, methamphetamine are linked with hyperglycemic events though their stimulation of sympathetic transmission. Elevated catecholamine levels counter the effects of insulin, and, in combination with missed doses of insulin, can lead to DKA [ ].
There is limited evidence available currently in the way of studies regarding the effect of cannabis use on people with T1D. Cannabis can interfere with glucose homeostasis indirectly via its appetite-promoting tendencies, and directly by an effect on gastrointestinal motility that can lead to vomiting.
Cannabis may also interfere with self-management routines [ ]. A recent study using the T1D Exchange Clinic Registry found that adults with T1D who reported moderate cannabis consumption had 2. This group was associated with a 4-fold earlier mortality rate compared to the general population [ ], with substance use being identified as a significant contributor [ , ].
A recent meta-analysis of longitudinal observational studies confirmed the deleterious effects of smoking on the health of people with diabetes. Compared with people who have never smoked tobacco, smoking had greater relative risks for early mortality RR 1.
People who had quit smoking showed lower levels of risk for cardiovascular events and death compared with active smokers, but still had higher rates compared with lifetime non-smokers [ ]. Data analysis by gender suggests that women who smoke have a greater risk for cardiovascular events and death compared with men.
However, men and women appear to benefit equally from quitting [ ]. The elevated risk for cardiovascular events and death associated with smoking can be attributed to its direct effect on insulin resistance, leading to worsening of glycemic levels as well as the propensity for atherosclerosis [ ].
It is also suggested that smoking is associated with more difficulties in diabetes self-management practices [ ]. The health effects associated with alcohol drinking among people with diabetes may follow a curvilinear relationship [ ].
People who drink 1 standard drink per day appear to have the lowest risk for cardiovascular events, even lower than people who abstain. People consuming over 2 drinks per day have an associated greater risk than abstainers. The associated cardiovascular risk increases linearly with every drink beyond 2 drinks per day [ ].
Alcohol is thought to be particularly detrimental to health when consumed in higher quantities. People diagnosed with alcohol use disorder experience worse outcomes compared to those without this condition. This includes higher odds ratio for myocardial infarction OR 1. Heavy drinking is also linked with negative diabetes outcomes, such as increased odds for diabetic neuropathy OR 1.
Similar to smoking, the effects of alcohol consumption in higher quantities appear greater among women relative to men with diabetes in terms of mortality [ , ]. Engaging in heavier alcohol consumption appears to be particularly detrimental to the health of individuals treated with insulin, who are associated with a 6- to fold greater risk for alcohol-related mortality compared with groups without diabetes matched for alcohol consumption [ ].
Beyond the direct effect on glucose homeostasis, alcohol use was also found to predict lower adherence with diabetes self-management behaviours [ ]. There is limited evidence that alcohol use disorder may interfere with participation in structured self-management diabetes education programs [ ].
Information regarding the effect of other substances such as opioids, cannabis, and stimulants on diabetes-related complications is limited at this time. However, one study found a greater odds ratio for early mortality in people with diabetes who use cocaine OR 1. Dealing with comorbid chronic pain may distract both providers and people with diabetes from focusing on the management of diabetes [ ].
This may partially explain why the use of prescribed opioids has been linked with poorer quality of diabetes care, including reduced lipid and glucose monitoring [ ]. There is limited evidence of the effect of long-term OAT on persons with diabetes. Nevertheless, the use of methadone as OAT has been linked with an enhanced preference for sugary or low nutritional quality foods that may promote weight gain and worsen diabetes management Table 2.
Systemic screening for and documentation of smoking status is widely endorsed in most health-care settings, and smoking cessation is promoted as a key activity for people with diabetes i.
Individuals who smoke tobacco should be offered support for quitting. Brief interventions for smoking even lasting just minutes include psychoeducation on the benefits of quitting, assessing the level of interest in making a quit attempt, and responding appropriately with treatment or referral for treatment 5As: A sk, A dvise, A ssess, A ssist, A rrange.
For those not ready to quit, a brief intervention can help individuals identify the relevance of quitting to support favourable diabetes and health outcomes.
Elucidation of the existing barriers and identification of opportunities for change can be achieved by discussing the 5Rs of smoking: R elevance, R isk, R eward, R oadblocks, R epetition. Brief interventions, such as the 5As and 5Rs, increase the odds of quitting successfully [ ].
People with T1D and T2D have similar success rates to populations without diabetes when using approved treatment for smoking cessation.
Quitting success is enhanced when individuals attempt to quit with approved pharmacotherapy e. nicotine replacement therapy, varenicline, bupropion, etc. combined with behavioural counselling [ , ]. Systematic screening for alcohol use in health-care settings can increase identification and timely treatment of alcohol misuse.
The most common screening tool for alcohol is the Alcohol Use Disorders Identification Test AUDIT-C. AUDIT-C screens for the frequency and intensity of alcohol consumption [ ].
Scores range from and a positive screen is 3 or 4 and above for women and men, respectively. These brief interventions are called SBIRT s creening, b rief i ntervention, and r eferral for t reatment , and have been shown to be effective for both the general population and people with T1D and T2D [ , ].
Recently, SBIRT has been delivered through the internet and found to be effective in reducing alcohol consumption among college students with T1D [ ]. Persons who are unable to make changes to their alcohol use on their own should be offered a referral to specialized addiction treatment.
Treatment consisting of addiction counselling and anti-craving pharmacotherapy is the mainstay of care for people with an alcohol use disorder.
Approved anti-craving pharmacotherapy e. naltrexone, acamprosate, or disulfiram increase the success of addiction psychosocial counselling and are safe for use in people with diabetes. The lowest risk for health-related harm was seen in people who consume 2 or less standard drinks per week [ ].
Alcohol consumption at a level of standard drinks per week is associated with increased risk for cancer, and 7 drinks per week or more increases cardiovascular risk [ , ]. Legalization of cannabis in Canada in led to an increase in use amongst all age groups, but young people in particular.
Legalization was followed by a position paper in from Diabetes Canada [ ]. These recommendations include avoiding cannabis use during adolescence, avoiding high-potency THC products i. concentrates and synthetic cannabis e. Following these recommendations may also reduce diabetes-related adverse effects that have been associated with cannabis, such as poor diabetes self-management, glycemic instability, and DKA [ ].
Individuals who are unable to decrease their cannabis use on their own should be offered a referral to specialized addictions treatment.
To date, there are no approved medications for the treatment of cannabis use disorder, and addiction counselling is considered the mainstay of care [ ]. Most recently, there is some evidence to suggest that glucagon-like peptide-1 GLP-1 receptor agonists may play a beneficial role in the treatment of a number of substance use disorders, including tobacco and alcohol.
Since this class of medications is currently approved for use in people with T2D, it may be helpful in the treatment of persons with co-existing T2D and substance use disorders [ ], however, conclusive evidence is lacking at this point in time.
A review article found that people with both T1D and T2D had increased rates of suicidal thoughts, suicide attempts, and completed suicide compared to the general population [ ]. A systematic review and meta-analysis of more than 50 studies reported that individuals with T1D have a risk of completed suicide 2.
A study of Canadian adolescents and adults reported that individuals with T1D had a higher lifetime prevalence of suicidal ideation A thorough literature review with practical recommendations for providers e. staff training, screening implementation, brief interventions, prevention efforts, and education and support tools for reducing suicide risk in youth and young adults with T1D is available [ ].
The COVID pandemic involved the institution of unprecedented public health measures, depleted an already overburdened health-care system, and set off highly polarizing misinformation wars.
Among the plethora of other physical and psychological symptoms and the impact on lifestyle-related behaviours, COVID appears to be a causative factor in the development of both T1D and T2D [ ].
A meta-analysis reviewing over 3, individuals found a pooled proportion of The CoviDiab Registry covidiab. com is a project developed by researchers and clinicians to record features of new-onset, COVID—related diabetes as well as severe metabolic disturbances in pre-existing diabetes i.
DKA, hyperosmolarity, severe insulin resistance. A bidirectional relationship appears to exist between COVID infections and diabetes [ ]. A United States Department of Veterans Affairs study of over , participants with no prior diagnosis of diabetes and who tested positive for COVID found that beyond the first 30 days of infection, survivors demonstrated increased risks and burdens for diabetes, and an increased use of antihyperglycemic agents [ ].
Pre-morbid diabetes is also associated with an increased risk of COVID complications. Outcomes for people who had COVID and diabetes but were without other comorbidities found an increase in severe complications, including pneumonia, excessive uncontrolled inflammation, a hypercoagulable state, and escalated glucose metabolism dysregulation.
The authors concluded that diabetes was a risk factor that would lead to rapid progression of symptoms and more severe negative health outcomes of COVID infections [ ]. Post-infection syndromes are common with other viruses, such as Epstein-Barr, cytomegalovirus, West Nile, and enteroviruses, and we must now add COVID to the list.
Debilitating symptoms that persist well past the acute phase of a COVID infection have been reported with increasing frequency in the general population [ ]. COVID infections can be divided into 3 phases: acute lasting up to 4 weeks , sub-acute lasting between 4 and 12 weeks , and chronic starting after 12 weeks.
While there is currently no standardized definition of long COVID, it can be at least conceptualized as the lack of a return to pre-infection state of health by weeks depending on the definition used. It appears to be triggered by a reaction to the virus that either does not resolve or causes new symptoms to appear after the acute phase of exposure to the virus.
Lacking formalized criteria for the diagnosis, pathognomonic symptoms, or definitive laboratory findings, long COVID involves a prolonged recovery that includes persistent physical and psychological symptoms. Long COVID has no set pattern to the development of symptoms and a variable course.
Those who experience it can have difficulty convincing others of their struggles with serious and persistent symptoms. The risk of developing long COVID involves only an exposure to the virus and has not yet been found to be related to the severity of the acute infection except for an intensive care unit admission, which is a predictive factor on its own.
End-organ damage in the acute phase and pre-existing illnesses especially respiratory appear to increase the risk. Other factors found to increase risk are advanced age, high BMI, and certain ethnicities [ ].
In the general population, females outnumber males by about 3 to 1 in experiencing long COVID symptoms. Being unvaccinated appears to approximately double the risk of developing long COVID as well [ , ].
The most commonly reported symptoms of long COVID are dyspnea, fatigue, cognitive impairment, and anxious and depressive symptoms, which can significantly impair the ability of individuals who also have diabetes to participate fully in diabetes self-management behaviours [ , ].
In summary, diabetes is associated with an increased risk of COVID complications [ ]. COVID vaccinations reduce the risk of developing long COVID [ ]. Because of the prevalence of DD and psychiatric comorbidity, and the negative impact that these factors have on glycemic management, early morbidity, and quality of life, it is recommended that individuals with diabetes be regularly screened with validated questionnaires or clinical interviews.
The available data do not currently support the superiority of any particular depression screening tool [ ]. Scales that are in the public domain are available at www. Patient Health Questionnaire PHQ-9 screeners are available at www.
Table 1 outlines the principal features and assessment methods to differentiate DD from MDD. In addition, it is recommended that diabetes providers assess for attitudes that underlie PIR and FoH in those for whom it appears to be appropriate.
Table 3 Features of psychological treatments that can be integrated into diabetes treatment. Efforts to promote well-being to mitigate distress should be incorporated into diabetes management for all individuals [ ]. Systematic reviews and meta-analyses have validated:.
Furthermore, coping skills, self-efficacy enhancement, stress management [ , ], and family interventions [ — ] all have been shown to be helpful [ 18 , — ]. Case management by a provider working with the primary care provider and providing guideline-based, person-centred care resulted in improved A1C, lipid levels, blood pressure, and depression scores [ , — ].
Evidence from systematic reviews of randomized controlled trials supports CBT and antidepressant medication, both individually or in combination [ , , ], for treating depression. No evidence presently shows that the combination of CBT plus medication is superior to these treatments given individually.
A pilot study of 50 people with T2D who initially had a moderate level of depression at baseline showed an improvement in the severity of their depression moving to the mild range with a week intervention of 10 CBT sessions combined with exercise in the form of minutes of aerobic activity weekly.
This effect was sustained at 3 months [ ]. Table 3 illustrates some of the major features of motivational interviewing, CBT, and acceptance and commitment therapy as applied to diabetes care. Gains from treatment with psychotherapy are more likely to benefit psychological symptoms and glycemic levels in adults than will psychiatric medications which usually reduce psychological symptoms only [ ].
Meta-analyses of psychological interventions found that they improved glycemic levels A1C in children and adolescents with T1D [ ], and adults with T2D [ ]. Furthermore, evidence suggests interventions are best implemented in a collaborative fashion and when combined with self-management interventions [ ].
Recent evidence also supports the effectiveness of mindfulness-based CBT [ , ]. Among adults with T2D and subclinical depression, CBT resulted in reductions in DD and depressive symptoms compared to controls [ ]. Lower diabetes regimen distress produced by an intervention combining education, problem-solving, and support for accountability led to improvements in medication adherence, physical activity, and decreased A1C over 1 year [ , ].
Recent research suggests that CBT can be used to address PIR by specifically addressing the beliefs that underlie it [ 33 , , , ] Figure 5. FoH is amenable to treatment, such as with the behavioural desensitization process illustrated in Figure 6 [ 36 , 37 , , ].
Since diabetes outcomes are heavily dependent on the sustained participation of the individual with the illness, motivational and behavioural change strategies can be effective. Optimism and compassion from providers has also been shown to be helpful [ , ].
Although information and technology—based psychological treatments for the management of depression in people with diabetes appear to be effective in decreasing depressive symptomatology, this unfortunately may not translate into significant improvements in glycemic levels [ ].
Psychological treatments delivered by non-specialists may be effective in improving glycemic levels. These treatments have some great potential of improving the quality of life for persons with T2D, particularly in low- and middle-income countries [ ].
Finally, there is limited evidence to support art therapy and yoga in managing emotional distress and improving diabetes control [ , ].
Psychiatric medications treat a wide array of symptoms and conditions. Wu Y, Zhang Y-Y, Zhang Y-T, et al. Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis. World J Pediatr. Lowes L, Lyne P, Gregory JW. Diabet Med.
Smaldone A, Ritholz MD. Perceptions of Parenting Children With Type 1 Diabetes Diagnosed in Early Childhood. Journal of Pediatric Health Care. Rankin D, Harden J, Waugh N, et al. Health Expect. Fornasini S, Miele F, Piras EM. The Consequences of Type 1 Diabetes Onset On Family Life.
An Integrative Review. J Child Fam Stud. Reynolds KA, Helgeson VS. Children with Diabetes Compared to Peers: Depressed? Clery P, Stahl D, Ismail K, et al. Systematic review and meta-analysis of the efficacy of interventions for people with Type 1 diabetes mellitus and disordered eating.
Semenkovich K, Berlin KS, Ankney RL, et al. Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes. Health Psychology. Viaene A-S, Van Daele T, Bleys D, et al.
Fear of Hypoglycemia, Parenting Stress, and Metabolic Control for Children with Type 1 Diabetes and Their Parents. J Clin Psychol Med Settings.
Gaudieri PA, Chen R, Greer TF, et al. Cognitive Function in Children With Type 1 Diabetes. Diabetes Care. Duinkerken E, Snoek FJ, Wit M. The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Dovey-Pearce G, Christie D. Transition in diabetes: young people move on — we should too.
Paediatrics and Child Health. Skipper N, Gaulke A, Sildorf SM, et al. Association of Type 1 Diabetes With Standardized Test Scores of Danish Schoolchildren. Kar P, Flury R, Ng S. Delivering the NHS Long Term Plan to ensure young people with diabetes have the care they need for their mental health.
pdf accessed Jun Whittemore R, Jaser S, Chao A, et al. Psychological Experience of Parents of Children With Type 1 Diabetes. Diabetes Educ. Ng SM, Katkat N, Day H, et al. Barnard K, Skinner TC.
Diabetes Duabetic be really tough to coja with. Sometimes people feel distressed, which can include feeling frustrated, comq, sad, or worried. Managing your diabetes can at times be stressful. Living with diabetes and managing it well can involve a lot of thinking, planning and problem solving. It can take a toll on your emotional well-being. It is understandable if you feel this way too.
Diabetes Herbal remedies for constipation a condition characterised xnd high Herbal remedies for constipation glucose smotional levels. Diabetic ketoacidosis typically occurs in people well-beig type 1 emktional, which was previously known Immunity-boosting foods juvenile diabetes or insulin dependent diabetes mellitus IDDMthough it can occasionally occur in type 2 diabetes. This type of coma is triggered by the build-up of chemicals called ketones. Ketones are strongly acidic and cause the blood to become too acidic. When there is not enough insulin circulating, the body cannot use glucose for energy.
Nicht hat ganz verstanden, dass du davon sagen wolltest.